title: Innovations in the endoscopic management of bladder cancer: is the era of white light cystoscopy over.
abstract: Bladder cancer is the most common tumor of the urinary tract, with a worldwide incidence of 8.6 x 100000 in men and 2.6 x 100000 in women (1). The majority of patients (75-85%) present as non-muscle invasive bladder cancer (NMIBC); within this category the most represented stage is Ta (70%), followed by T1 (20%) and, less frequently, carcinoma in situ (CIS) (10%) (2). The diagnosis of NMIBC and, more generally, of bladder cancer, depends on urine cytology and endoscopic examination with histological evaluation of the resected tissue. Clearly, an optimal cystoscopy with accurate transurethral resection (TUR) is of great importance in order to improve the detection rate and to reduce the probability of recurrence and progression. Today the cystoscopy is routinely performed with the white light technique (WLC), the same of about 80 years ago (3). Several studies have demonstrated that an initial TUR with WLC can miss small papillary lesions and, particularly, flat lesions such as CIS. Moreover, recurrence rates of non-muscle invasive bladder cancer (NMIBC) are directly related to the possibility of achieving a complete resection: residual cancer is present in a large percentage of re-TUR, showing a not so good performance of resection with this method. For these reasons new methodologies have been investigated in order to improve the sensitivity and specificity of WLC, such as photodynamic diagnosis (PDD), narrow band imaging (NBI), optical coherence tomography (OCT) and CT virtual cystoscopy. Some of them have been well established and supported by consistent literature while others are still to be viewed as experimental. The purpose of this review is to investigate the state of the art of these new techniques.
authors.affiliation: University of Turin, Division of Urology, A.O. Città della Salute e della Scienza, Molinette, Turin - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Soria
authors.forename: Alberto
authors.initials: A
authors.lastname: Gurioli
authors.forename: Francesca
authors.initials: F
authors.lastname: Peraldo
authors.forename: Marco
authors.initials: M
authors.lastname: Oderda
authors.forename: Simone
authors.initials: S
authors.lastname: Giona
authors.forename: Emanuele
authors.initials: E
authors.lastname: Ambrosini
authors.forename: Bruno
authors.initials: B
authors.lastname: Frea
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
mesh_terms: D000622:Aminolevulinic Acid / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D002278:Carcinoma in Situ / Q000175:diagnosis; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D003558:Cystoscopy / Q000295:instrumentation / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D005544:Forecasting; D006801:Humans; D008027:Light; D008297:Male; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D017319:Photosensitizing Agents / Q000493:pharmacokinetics; D011524:Protoporphyrins / Q000032:analysis / Q000528:radiation effects; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence; D014057:Tomography, X-Ray Computed / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*
chemical_list: D017319:Photosensitizing Agents; D011524:Protoporphyrins; D000622:Aminolevulinic Acid; C028025:protoporphyrin IX; C419924:5-aminolevulinic acid hexyl ester